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Federal forms, ICRs, and supporting documents

Information Collection Request

Letter Requesting Waiver of Medicare/Medicaid Enrollment Application Fee; Submission of Fingerprints; Submission of Medicaid Identifying Information; Medicaid Site Visit and Rescreening

ICR 201103-0938-001 · OMB 0938-1137 · Historical Active

Forms and Documents
Document
Name
Status
Supplementary Document
2011-06-23
Supplementary Document
2011-06-23
Supporting Statement A
2011-03-01
IC Document Collections
IC ID
Document
Title
Status
194901
Modified
194900
Modified
194899
Modified
194898
Modified
194897
Modified
194896
Modified
194895
Modified
ICR Details
0938-1137 201103-0938-001
Historical Active 201010-0938-005
HHS/CMS
Letter Requesting Waiver of Medicare/Medicaid Enrollment Application Fee; Submission of Fingerprints; Submission of Medicaid Identifying Information; Medicaid Site Visit and Rescreening
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 07/20/2011
Retrieve Notice of Action (NOA) 03/01/2011
  Inventory as of this Action Requested Previously Approved
07/31/2014 36 Months From Approved
960,981 0 0
1,248,082 0 0
0 0 0
On March 23, 2010, the President signed into law H.R. 3590, the Patient Protection and Affordable Care Act (Affordable Care Act), Public Law 111-148. Section 6401 of the law establishes a number of important payment safeguard provisions, several of which have been incorporated into CMS Proposed Rule 6028, entitled "Medicare, Medicaid, and Children's Health Insurance Programs (CHIP); Additional Screening Requirements, Application Fees, Temporary Enrollment Moratoria, Payment Suspensions and Compliance Plans for Providers and Suppliers," and published in the Federal Register on September 23, 2010. The provisions are designed to improve the integrity of the Medicare, Medicaid, and CHIP programs so as to reduce fraud, waste and abuse.
PL: Pub.L. 111 - 148 6401 Name of Law: Provider Screening and Other Enrollment Requirements Under Medicare, Medicaid & CHIP
  
PL: Pub.L. 111 - 148 6401 Name of Law: Provider Screening and Other Enrollment Requirements Under Medicare, Medicaid & CHIP
0938-AQ20 Final or interim final rulemaking 76 FR 5862 02/02/2011
No
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 960,981 0 889,481 71,500 0 0
Annual Time Burden (Hours) 1,248,082 0 1,105,082 143,000 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
This is a new information collection request.
$11,990,572
No
No
Yes
No
No
Uncollected
William Parham 4107864669
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
03/01/2011